Provider Demographics
NPI:1649679416
Name:FULCO, LISA M (MA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:FULCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HILLE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2010
Mailing Address - Country:US
Mailing Address - Phone:201-567-1500
Mailing Address - Fax:
Practice Address - Street 1:64 E MIDLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2934
Practice Address - Country:US
Practice Address - Phone:201-498-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health